[Tubal sterilization in the new unified Germany -- results of a survey]

The German Federal Republic had issued a total of four statistics about pelviscopy covering the period of 1949 through the end of 1988. In contrast the new federal provinces issued such statistics only in recent years. In 1989 the number of such sterilizations amounted to about 800 cases. In 1992 and 1993 questionnaires were sent to 198 clinics inquiring about the number of tubal sterilizations that had occurred during May 1991 and June 1992. 133 valid responses were received. The total number of tubal sterilizations were 20915: 18873 (90.3%) by pelviscopy 1199 (5.7%) by minilaparotomy and 732 (3.5%) via the vaginal route. The highest number of procedures (13129 or 69.9%) were performed by means of bipolar HF technique followed by endocoagulation (3972 cases or 21.0%) monopolar HF technique (87 cases or 0.5%) and laser technique (33 cases or 0.2%). Among mechanical methods 1095 sterilizations (5.8%) were done by means of clips and 557 (2.9%) by means of rings. 48 (24%) clinics reported complications 37 of them severe complications which required laparotomy. The most frequent were intestinal lesions (15 cases) and intra-abdominal bleeding in 14 cases required further operative intervention. There were 2 cases of injury to the retroperitoneum and 1 case of stomach perforation. In addition 79 cases of light complications were also reported. Preperitoneal emphysema occurred in 30 cases bleeding from the trocar insertion in 10 cases and epigastric hematoma in 12 cases. In 8 patients an adnexitis and a tubo-ovarial abscess developed postoperatively. Perforation of the uterus with the adapter occurred in 2 cases. Furthermore the clip was lost in the abdomen in 2 endoscopic tubal sterilizations. Narcosis incidents were described in 3 cases. 15 women had to undergo laparotomy because of the failure of endoscopic technique. This happened because operations using laparoscopy are still novel in the new federal provinces and partly because of inadequate equipment. The rate of failures amounted to 3/1000 which corresponds to the rate reported in the literature.